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Selected Honors Theses

Spring 2016 Best Practice Methods for Social Work with North Koreans Bethany Johnson Southeastern University - Lakeland

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Best Practice Methods for Social Work with North Koreans

Bethany Johnson

Southeastern University

SOCIAL WORK WITH NORTH KOREAN 2

Abstract

The people of North Korea are in deep need of social work aid. This systematic literature review highlights key best practices for working with North Koreans, both in and out of their home country. Areas of work highlighted included addressing mental illnesses, specifically PTSD, reintegration into South Korea and other neighboring nations, advocating for international human rights policies, and humanitarian aid. Specific best practice suggestions are made for each section. In addition to this review, interviews were conducted with two expert professors in order to gain greater insight on the topic.

Key Words: North Korea, social work, refugees, humanitarian, mental health

SOCIAL WORK WITH NORTH KOREAN 3

Table of Contents

Chapter One: Introduction.………………………………………………………………. 4

Chapter Two: Methodology……………………………………………………………….7

Chapter Three: Out-of- Country Response………………………………………………..9

Mental Health……………………………………………………………………...9

Reintegration……………………………………………………………………..14

Chapter Four: In-Country Response……………………………………………………..20

Policy…………………………………………………………………………….20

Humanitarian Aid………………………………………………………………...25

Chapter Five: Conclusion………………………………………………………………..38

References………………………………………………………………………………..39

Appendices……………………………………………………………………………….48

Appendix A: Interview with Dr. Chang………………………………………….48

Appendix B: Interview with Dr. Toshima……………………………………….50

SOCIAL WORK WITH NORTH KOREAN 4

Chapter One: Introduction

In the year 1950, a civil war began in the East. Korea, a nation liberated from

Japanese rule only 5 years prior was now at odds with itself. In the North, the Russian army influenced the public towards Communism, and in the South, the United States influenced the nation towards democracy. In 1953, three years later, the country was in ruins, with not much to show for its efforts. There were countless causalities on both sides, severe damage to the land and economy and still no peace treaty, simply an armistice and a divide at the 38th parallel (Maass, 2014). In actuality, the war continues today (Kim, Kim & Torrey, 2008).

In the years following, both North and South Korea were left to pick up the pieces of their now individual nations. While democracy was instilled in the South, a supreme leader rose in the North. Kim Il Sung, a man considered to be God himself, established the Juche, or “self-reliance” philosophy and a dynasty that still rules the nation today

(Myers, 2008). Sadly, while the South developed into a world power with a strong economy and international voice, the North only continued to decline. Closed off to any outside help, the people of North Korea have lived in desolate conditions for the past 70 years. The government uses what small resources it has to fortify its military and nuclear weapons, while the country’s people continue to die of starvation (Aaltola, 1999). In addition, the Kim dynasty has taken liberties to severely restrict the human rights of

North Koreans, impeding freedoms of speech, religion, career, travel, and even personal thought. Multiple concentration camps have been established throughout the country for individuals and their families who have committed any type of infraction against the

Great Leader, and public executions are not uncommon (Kim et al., 2008). It is obvious SOCIAL WORK WITH NORTH KOREAN 5 that the people of North Korea are in desperate need of intervention, and who better to enact needed change than social workers?

Professional social workers are trained to be advocates, brokers, mental health counselors, mediators, policy makers, and many other roles this population is in immediate need of (Lough, 2014). This systematic literature review will outline the best practices social workers can use to assist the people of North Korea, both inside and outside of the country.

In order to put together a comprehensive guide to best practices, action steps have been divided into out-of-country and in-country need. Because life inside North Korea is drastically different than life in the outside world, separate areas of practice are highlighted in order to best meet the unique needs of the people living in North Korea, as well as those who have managed to escape their native country, and now reside in territories such as China, South Korea and the United States.

For practitioners wishing to work with those who have escaped, the areas of mental health treatment and community integration are addressed. Not only living in

North Korea, but escaping under life threatening conditions has been found to be a breeding ground for complex trauma (Jin Yong et al., 2015). Because of this, practice methods for addressing Post Traumatic Stress Disorder and other trauma related illnesses are the focus concerning mental health. Community reintegration is also addressed because of the stark differences between daily life in North Korea and the outside world.

North Korean refugees not only face unfamiliarity with the modern world, but widespread discrimination due to their home country’s unsavory reputation (Jin & Yeol,

2014). SOCIAL WORK WITH NORTH KOREAN 6

In addition to those who have successfully escaped their oppressive government, there is hope to be had for the individuals who continue to reside in North Korea, and for the social workers and other helping professionals who desire to come to their aid as well.

For the section on in-country need, interventions in the sphere of public policy and humanitarian aid organizations will be the focus. Foreign relations, responsibilities, and points of action are addressed, in order to create change at the macro level. In addition, international humanitarian aid organizations have proven to be a large positive influence on the nation’s people and its leaders (Kim, 2012). The most successful practices for these organizations are highlighted as well.

SOCIAL WORK WITH NORTH KOREAN 7

Chapter Two: Methodology

In order to compile this systematic review, research was conducted through a comprehensive review of the scholarly literature on this topic. In addition, interviews of university professors with extensive knowledge on the subject were used as additional sources.

In order to accumulate data, researchers utilized the library databases at a university in the Southern United States, primarily EBSCO, to find scholarly, peer reviewed journal articles. When searching these databases, the key terms “North Korea,”

“social work practice,” “humanitarian,” “PTSD,” “refugees,” and several others were used. In addition to these terms, researchers narrowed down the selection of articles by reviewing the journal in which they were published. Well-known social work journals were used, in addition to esteemed journals on international policy and psychology.

Lastly, the selection of articles was narrowed down to those that had relevant, new information applicable to the topic. By looking for themes and research studies with high validity and reliability in the field, the researcher was able to narrow down these selected methods that could be considered best practices while working with this population.

As previously mentioned, interviews were conducted in order to collect additional data. The researcher traveled to Southwest China for humanitarian purposes in May of

2015, a region where many North Korean defectors pass through on their search for freedom (Song, 2013). While in this region, she was connected with Dr. Chang, a professor from a well-known university in Southwest China, for the purpose of finding more information on best practice in public policy. Dr. Chang disclosed the extent of his knowledge on the history of the relationship between China and North Korea, going back SOCIAL WORK WITH NORTH KOREAN 8 to World War II (Chang, personal communication, May 25, 2015). He also expressed his own views and experiences concerning North Korea. Dr. Chang spoke extensively on what he believed was China’s role in Korean affairs, and what he predicted would come of North Korea and China’s relationship. Throughout the interview, all researcher prompts were pre-planned and approved by the International Review Board of Florida.

All names have been changed to maintain confidentiality.

In addition, the researcher was able to interview Dr. Toshima, professor of

Intercultural Studies at a university in the Southeast region of the United States. Dr.

Toshima has extensive experience working in Southeast Asia, in a religious and humanitarian context. In addition, he is the chairman and founder of his own humanitarian organization, which happens to be one of the only few working in

Pyongyang, North Korea. In his interview, Dr. Toshima discussed his organization, why they continue to be effective, and what he would recommend to other humanitarian organizations seeking to work with this population (Toshima, personal communication,

November 30, 2015). As with Dr. Chang’s interview, all questions were pre-planned and approved by the Institutional Review Board of Florida, and all names have been changed in order to maintain confidentiality.

SOCIAL WORK WITH NORTH KOREAN 9

Chapter Three: Out-of-Country Response

Mental Health

One of the most crucial facets of life that will need to be addressed when dealing with North Koreans who have become refugees is their mental health. Mental illness, although often untreated, can affect every aspect of a person’s life and well-being.

Studies and systematic reviews of mental illness in refuges have identified prevalence rates high above those of the average population (Bogic, Njoku & Priebe, 2015). In one review, a sample of 16,010 refugees revealed that 80% were diagnosed with depression,

86% PTSD, and 88% unspecified anxiety (Bogic et al., 2015). It is well known throughout the mental health community that these three illness often run together, and this relationship is deeply discussed in studies such as Byllesby, Durham, Forbes,

Armour, & Elhai’s (2016) in the Journal of Psychological Trauma. But for the sake of conciseness and applicability, this literature review will focus on PTSD, its unique characteristics and manifestation in North Korean refugees, and best treatment modalities.

In order to focus in on key concepts practitioners need to be aware of when treating PTSD in North Korean refugees, four main concepts are highlighted and discussed in this section. The concepts are as follows:

North Korean refugees experience unique traumas, unlike others typically associated with PTSD in South Korea or the United States.

North Korean refugees experience significant traumas, not only through their life, but especially upon their escape from their native home. The most common traumas reported are often underlined with political suppression, violence and poverty (Jeon, SOCIAL WORK WITH NORTH KOREAN 10

Eom, & Min, 2013). Such events are infrequently one time instance, but often experienced or witnessed throughout the childhood and lifetime of a North Korean (Jeon et al., 2013). According to a study conducted by Jeon and colleagues (2005) with 258 refugees:

Of these traumatic events, the event with the highest frequency was ‘witnessing public executions,’ followed by ‘hearing news of the death of a family member or relative due to starvation,’ ‘witnessing a beating,’ ‘witnessing a punishment for political misconduct,’ and ‘death of a family member or relative due to illness.’ (p. 150)

These traumas are staunchly different than traumatic events practitioners may come in contact with more commonly in the United States, such as war combat, sexual abuse, or domestic violence (Watts, Zayed, Llewellyn-Thomas, & Schnurr, 2016).

Although all of these traumas are uniquely significant and horrific in their own right, practitioners will need to recognize the unique nature of the North Korean refugee’s experience, and take all into account throughout assessment and treatment.

In terms of the most severe traumas, incidence of forced return to North Korea after attempted defection has shown to increase the severity of PTSD and related symptoms in refugees (Kim, Kim & Lee, 2013). These forced returns often lead to increased instance of traumatic events, including, but not limited to, physical torture, imprisonment, or even execution (China’s repatriation of North Korean refugees, 2012).

The increased possibility and severity of these events give evidence as to why refugees are more likely to experience severe symptoms of PTSD and other mental illnesses, and opposed to other defectors who were not caught and returned to their country.

In addition to forced repatriation, research has shown that family-related traumas SOCIAL WORK WITH NORTH KOREAN 11 showed the greatest potential for later causing PTSD (Jeon et al., 2005). This could include witnessing the harm or death of a family member, worry or stress about missing family member, or any trauma related to human relationships (Jeon et al., 2005). It is evident that the need for human connectedness, especially in the midst of stressful circumstances, is transcendent across country and culture, and essential for the well being of all people.

Certain characteristics, including age, education and health may affect a North Korean refugee’s propensity to develop PTSD.

In addition to the presence or lack of presence of traumatic events, personal characteristics can also be contributing factors to the development of a North Korean refugee’s PTSD. Primarily, age can be a contributing factor. According to Kim and colleagues (2013) in their study of 2,163 North Korean women, older female refugees had a higher propensity to psychological distress.

In addition, women with a higher education generally had a higher quality of mental health (Cho, Jeun, Yu & Um, 2005; Kim et al., 2013). Although there is almost no opportunity for educational advancement in North Korea, especially for women, those who were gifted with some education were able to use that knowledge as a sort of

“psychological buffer” (p. 1099) against PTSD and other trauma related symptoms (Kim et al., 2013).

Lastly, and maybe more obviously, refugees with higher qualities of physical and mental health are less susceptible to develop PTSD or like symptoms (Kim et al., 2013).

Not only are the physically and mentally vulnerable more likely to suffer psychologically, they are likely to not make the trip from North Korea to freedom at all. SOCIAL WORK WITH NORTH KOREAN 12

Due to the severe hazards of the trip, it is likely that the vulnerable, the elderly, less educated, and ill, may never make it to their intended destination (Kim et al., 2013).

The implications for practice in this instance are that any refugee who makes it to

South Korea, or neighboring countries, will already have exhibited high levels of resilience. No matter their current state, the sheer fact that they have survived the trip shows that they are capable of overcoming much, including lingering PTSD and mental illness.

North Korean refugees experience unique symptoms of PTSD.

In the research previously mentioned, the symptom profiles of PTSD, as well and other related disorders, were very similar in both North Korean refugees and South

Koreans alike (Jeon et al., 2013). That is, with one exception. Irritability and outbursts of anger were highly ranked symptoms of PTSD for the North Korean refugees participating in this seven-year longitudinal study (Jeon et al., 2013). While at first this distinction may seem unusual, or even insignificant, it starts to make sense when cultural factors are taken into account. North Koreans are told their whole life that their country is the best and most powerful on earth, and that their leaders are God-like. They are denied access to travel or to any information of the outside world, of freedoms and opportunities, through television or the Internet. Once a North Korean enters the outside world, it is very common to react with anger at having been intentionally deceived for an entire lifetime

(Jeon, Min, Lee & Lee, 1997). It is important for clinicians to recognize this anger as a symptom of trauma, and address it accordingly. In addition, it is essential that practitioners validate this anger as understandable and even appropriate, while equipping

North Korean refugees to express and cope with this anger in healthy ways. SOCIAL WORK WITH NORTH KOREAN 13

Approaching treatment from multiple perspectives may be most effective when treating

PTSD in refugees.

Once a practitioner is familiar with all a North Korean refugee’s unique traumas, characteristics and needs, it is essential to address the best therapeutic approaches to treat their PTSD. It has been widely agreed upon in the mental health community that cognitive behavioral therapy (CBT) is the most tested and most effective approach, according to current research (Drožđek, 2015). But does this still apply in a multicultural context? Specifically when working with North Korean refugees, clients will have been exposed to trauma before their departure from their country, during their migration, and then face continued stressors that come with reintegration into a new country and culture.

In his overview of the challenges of treating PTSD in refugee populations,

Drožđek (2015) explains that two contrasting approaches are often applied: trauma- focused therapy or multimodal interventions. Trauma-focused therapies are those, like

CBT or EMDR, that aim to directly address traumatic events and PTSD symptoms, while multimodal treatments address a wide variety of things, such as current biological, psychological and sociological functioning, as well as acculturation difficulties (Drožđek,

2015; Drummond, Lee, & McGuire, 2014).

So which of these is better? Research would suggest that actually a combination of the two would be most effective, rather than choosing one over the other (Drožđek,

Kamperman, Tol, Knipscheer, & Kleber, 2014). Although there is more research to back up the effectiveness of CBT and other trauma-focused therapies in reducing PTSD symptoms, the comprehensiveness of a multimodal approach, that includes trauma- focused practices, addresses a wide range of symptoms and may be a big advantage to SOCIAL WORK WITH NORTH KOREAN 14 practitioners (Drožđek, 2015). Although the multimodal approach may not target specific

PTSD causes and symptoms as much as a strictly trauma-focused model might, it does address other areas of the client’s life that can directly affect their mental health

(Drožđek, 2015).

Another fringe benefit of combining both the trauma-focused and multimodal approaches is that it may be useful for clients who are apprehensive towards mental health treatment. Research shows that many North Korean refugees may be hesitant towards psychotherapy (Kim et al., 2013). This is not surprising, considering the near complete lack of mental health services available in North Korea (Kim et al., 2013). By addressing less intrusive problems, such as acculturation and physical health, practitioners may ease refugees into the helping process, and therefore allow an open door to address deeper traumas once the client is ready.

Reintegration

In addition to meeting the mental health needs of North Korean refugees, it is essential that social workers and other professional address the process of reintegration.

North Korea is often referred to as the “hermit kingdom” (Strand, 2004, p.20), as it leaves its citizens effectively cut off from the rest of the world. When defectors enter into a new nation as refugees, it is like entering a whole new world. Even if they settle into South

Korea, a nation that was synonymous with their own only seventy-years prior, the differences in everyday life are remarkable. Refugees must relearn everything, from dialect to public transportation to job applications to bank accounts; everything is new. SOCIAL WORK WITH NORTH KOREAN 15

In order to make the transition to new life easier, there are multiple best practices social workers and other practitioners can utilize. Three of these key practices are highlighted below:

Encourage reintegration to South Korea specifically.

Research shows that South Korea, rather than other Southern Asian countries or the United States, has proven to be the most nurturing environment for North Korean refugees. Being in the right environment can positively influence multiple areas of a refugee’s life, including mental health. Research evaluating PTSD in refugees found that

North Koreans who relocated to South Korea coped with their mental illness remarkably better than comparative populations from other Southeast Asian countries that relocated to the United States or Japan (Jeon, 2013). Researchers attributed this disparity to similarities in language, culture and available government assistance (Jeon, 2013).

With this said, there are still many improvements that could be made to the South

Korean reintegration and assistance system. Although shared language and similar culture definitely help with the process, it is not enough to develop well-adjusted citizens.

This leads to the second best practice suggestion:

Encourage and develop additional assistance programs, training resources and support systems.

In 2009, it was estimated that there were approximately 15,000 North Korean refugees in South Korea (Bidet, 2009). As of March 2014, this number had already skyrocketed to 26,483 (Myong-Hyun, 2014). Although South Korea has developed some great programs for refugees, these ever-growing numbers present new problems for both the South Korean agencies and North Korean refugees. SOCIAL WORK WITH NORTH KOREAN 16

When North Koreans first enter South Korea, they are automatically given a unique status. Although they are technically considered South Korean citizens, they must first enter an intense screening process by the South Korean government (Myong-Hyun,

2014). Once they have passed the screening process, every North Korean enters

Hanawon, a government institution where they will live for the next twelve weeks. Here, the refugees attend extensive educational courses where they receive job training, education on the economy and history of South Korea, as well as health and psychological examinations (Cho & Kim, 2011). After leaving Hanawon, the South

Korean government provides refugees with a one-time resettlement payment and housing assistance, as well as a “resettlement helper,” or who one might refer to as a case manager, for up to two years (Myong-Hyun, 2014).

Although these programs are a great start to North Korean aid, research shows that they are not quite enough to successfully integrate North Korean refugees into society. For one thing, almost all of the offered programs are short term. Twelve weeks is certainly not long enough to learn a completely new way of life, just as two years is rarely enough time to be functioning without any assistance at all. Although this may seem like a long time at first glance, North Korean refugees have many things working against them in the reintegration process. This often includes health deficits from a lifetime of enduring food shortages, psychological traumas already discussed, low levels of education, discrimination, as well as other factors (Myong-Hyun, 2014); (Pak, 2010).

In order to combat these hindrances, social workers and other professionals need to develop unified programs to facilitate long-term help. This may include additional food and housing assistance, additional educational training, and prolonged psychological SOCIAL WORK WITH NORTH KOREAN 17 counseling. With these types of additional assistance, North Korean refugees would hopefully not only have a successful short term entry into South Korea, but a successful integration into the rest of society for the remainder of their life.

The last suggestion to facilitate best practices with reintegration is in direct reference to one of the specific hindrances previously mentioned:

Advocate against discrimination.

Readjusting to normal life in a new country and new culture can be extremely challenging for anyone, and this proves true in the lives of many North Korean refugees.

Polls conducted by the East Asia Institute have shown a significant decrease in connected between North and South Koreans (Myong-Hyun, 2014). In 2005, 75% of South Koreans expressed feeling some degree of closeness to the North Korean people, but that number dropped significantly to 50% a mere five years later (Myong-Hyun, 2014). Other studies suggest that these negatives attitudes towards North Koreans are perpetuated primarily by the younger South Korean population, those in their twenties and younger, in contrast to those in their sixties and older (Lee & Sohn, 2011). Researchers attribute this generational disparity to the fact that the two Koreas have been separated for more than seventy years. While the older generation remembers a unified Korea, younger South

Koreans no longer consider North Korean as part of their country. This separation perpetuates “mistrust, unfair treatment, ostracism, and discrimination, even outright hostility,” against North Korean refugees (Myong-Hyun, 2014, p.10)

This extent of discrimination can impact many areas of a refugee’s life, one of the primary sectors being social functioning. In one study, results showed that social adjustment among defectors was rather poor, especially among those who had PTSD, SOCIAL WORK WITH NORTH KOREAN 18 which was 54.9% of the participants (Chung & Seo, 2007). Overall, social adjustment was significantly low in the areas of family relationships and financial management. This indicates that discrimination not only hindered refugees from connecting to society as a whole, but even impacted the way they connected to their families and life responsibilities (Chung & Seo, 2007).

Other scholarly works present evidence on why social adjustment might be difficult in certain areas, specifically financial management. With a large influx of North

Koreans coming into the South in recent years, the labor market has been unable to adapt to the large number of unspecialized workers (Bidet, 2009). Not only has the labor market been unable to adapt, but the South Korean people have struggled to accept their new neighbors. North Koreans are severely discriminated against when it comes to finding jobs, not only because they have few skill sets, but also because they are refugees, and struggle making ties with their new country. It is obvious that North Koreans will continue to face trouble and discrimination in the workplace until further action by South

Korea is taken (Bidet, 2009).

Looking at the host of disadvantages North Korean refugees must already overcome, additional discrimination should not be on the list. This is an issue social workers, whether they be Korean or international, should be able to easily advocate against. Advocacy and practice against such discrimination goes farther than just perceived acceptance, but as research exemplifies, could enhance an refugee’s family, work situation, and overall quality of life.

The reintegration of North Korean refugees into other cultures is not only a good idea, but a necessary action. When practitioners adhere to these best practices, supporting SOCIAL WORK WITH NORTH KOREAN 19 reintegration to South Korea, encouraging greater services, and advocating against discrimination, social workers will see a healthier refugee population, and healthier communities as a whole.

SOCIAL WORK WITH NORTH KOREAN 20

Chapter Four: In-Country Response

Policy

Although it may not be the primary role that comes to mind when thinking of social workers, policy practice has been an integral part of the profession since the its origins (Mosley, 2013). Policy practice consists of advocating at governmental levels for change in the name of clients. Although social workers are not the main proponents of most international policy concerning North Korea, they definitely have a voice in what that policy should look like.

International policy applicable to North Korea consistently revolves around two main topics: security and human rights (Howe, 2012). Although these policies come from multiple international sources, including the groups such as the European Union, the biggest proponents of these policies have been South Korea, the United States, Japan and

China (Lee, 2012). This section will highlight the primary model of North Korean policy from each influential country, and end with best practice implications for future policy.

To start, the nation that likely possesses the most significant influence over North

Korea is South Korea. With that said, South Korea has yet to pass significant legislation that outlines their stance on North Korea (Wolman, 2013). This hesitance to pass significant legislation is due to the polarized opinions of progressives and conservatives in the country. Although government programs have been instituted, such as Hanawon and other non-government organizations, South Korea has been unable to come to any significant unified legislative decisions. While conservatives in South Korea would like to see blatant opposition against the North Korean human rights violations, progressives SOCIAL WORK WITH NORTH KOREAN 21 are advocating for humanitarian aid, without such harsh criticisms, as to not offend the

North Korean government and possibly jeopardize their own security (Wolman, 2013).

In order to overcome this state of stagnancy, scholars suggest that the government remove this issue from domestic politics, and instead engage in global efforts to address

North Korean issues, whether they be in reference to security or human rights (Wolman,

2013). It appears that this issue may be too close to home to make unified, unbiased decisions, and by keeping this issue at the domestic level, South Koreans are unable to make any headway because of their opposing governmental forces. This not only impedes them from helping their brothers in the North, but keeps them from focusing on their first responsibility: their own people. By making this a global issue, South Korea would not only gain the power of multiple nations, but gain perspective and unbiased knowledge as well (Bo-hyuk, 2013).

In addition to South Korea, the United States and Japan have both made significant policy stances concerning North Korea. Most notably, both nations have passed the North Korean Human Rights Act, a piece of legislation that identified both the

United States and Japan in strong opposition against human rights violations and nuclear weapon possession in North Korea (Hwang & Kim, 2006). Both countries sought to not only improve international security, but also improve the lives of the North Korean people by enhancing their human rights.

Although this legislation has notable intentions, it is unclear how effective it truly is. Some scholars suggest that the North Korean Human Rights Act, although it may sound good, has no real influence over North Korea (Hwang & Kim, 2006). In all reality, the United States and Japan can’t make North Korea enhance the rights of their people by SOCIAL WORK WITH NORTH KOREAN 22 simply passing a law. Because of its limitations in the areas of law and foreign security, this act might actually be doing more harm than good. Although it has good intentions, the staunch stance of this act may simply be putting the United States and Japan at odds with the North Korean government, with no tangible benefits for the North Korean people to make this divide worth it (Hwang & Kim, 2006).

Lastly, China, an extremely influential neighbor to North Korea, has taken its own unique stance. China’s main approach to matters with North Korea has been “neighborly engagement” (Delury, 2012, p.71), meaning their diplomatic relations are focused on mutual benefit in politics, economics, and global affairs.

Chinese professor, Dr. Chang, had much to say about this relationship when he sat down with the researcher in the spring of 2015. Following is a brief summary of his perspective on the Chinese-North Korean relationship:

According to Dr. Chang, China and North Korea had a very strong relationship during the reign of Kim Il Sung (Chang, personal communication, May 25, 2015). The

Chinese and North Koreans fought together during World War II and the Korean War, and were unified largely because of their support for Communism. But since the death of

Kim Il Sung and the subsequent reign of his sons, this relationship has deteriorated. North

Korea became upset with China when they opened up to the outside world, and China became frustrated with North Korea as they continued to pour money into the country.

From Dr. Chang’s perspective, China now views North Korea as a misbehaving child. China essentially pays North Korea not to misbehave, and this is how the North

Korean government continues to sustain itself. Although China wants good relations with

North Korea, they also want them to behave. SOCIAL WORK WITH NORTH KOREAN 23

When asked about Chinese policy in reference to North Korean human rights, Dr.

Chang responded that the nuclear weapons issue, just like economic affairs, will always outweigh human rights issues, in terms of Chinese involvement. In addition, Dr. Chang posed the suggestion that China may not want to make accusations against North Korea for fear that others may be able to use the same arguments against them. All in all, it appears as if China genuinely wants peace with North Korea, and is taking the route of mutual benefit in order to achieve that peace (Chang, personal communication, May 25,

2015).

When looking at the approach of each of the key players in North Korean policy, it is obvious that there is great diversity in terms of approach. But after looking at each policy, some stand out greater than others. In terms of best practice strategies for North

Korean policy, there are two main suggestions to which social workers can adhere:

Follow China’s strategy of peace and commitment.

Although other policy makers, such as those in the United States and Japan, may not agree with China’s almost friendly relations with North Korea, research suggests that

China actually has the most successful diplomatic relations with North Korea (Delury,

2012). This is mostly attributed to China’s commitment to continually engage North

Korea. Once the United States and South Korean policies failed to make significant headway, they largely stepped out of the picture. If the United States and South Korea could find a way to work with and possibly even mimic China’s commitment to engagement, they may gain real influence in the nation of North Korea (Delury, 2012).

In addition to following China’s lead in peace and commitment, there is one more key facet that could lead to success in addressing North Korea through legislation: SOCIAL WORK WITH NORTH KOREAN 24

Multiple nations should approach North Korean policy together.

As mentioned earlier in relation to South Korea, engaging in global efforts to make policy, rather than trying it alone, gives individual nations the benefit of greater power through numbers, and greater knowledge through multiple perspectives.

This process was briefly begun with the Six Party Talks, a series of conversations between the Unites States, China, North Korea, South Korea, Russia and Japan concerning North Korea’s nuclear weaponry (Shulong & Xinzhu, 2008). These conversations were initially successful in the early 2000’s, but were overall ineffective once North Korea refused to follow restrictions later in the process (Chung, 2013) .

Although these conversations did not prevent North Korea from having nuclear weapons, they began the conversation on this topic with multiple nations. A continuation of this approach to policy is definitely a great place for the United States, South Korea and other nations to begin moving forward on this issue (Shulong & Xinzhu, 2008).

Secondly, approaching North Korean policy globally gives each nation the benefit of knowledge from multiple perspectives. It is commonly known that each nation possesses a unique worldview developed through culture and common experiences, but research suggests that even knowledge of concrete events varies between nations.

A study conducted by analyzing school textbooks in the United States, South

Korea, Japan and China, found that each country’s perspective and knowledge on the

Korean War is very different (Lin, Zhao, Ogawa, Hoge, & Kim, 2009). Staggering discrepancies were found in who started the war, how much causality each country accumulated, and many other details important for understanding this significant world event. If each of these nations has a different idea of what even began the separation of SOCIAL WORK WITH NORTH KOREAN 25

Korea, no wonder they each have responded so differently to human rights in North

Korea. If each of these influential countries could work together globally, one could hope for greater success in policy directly relating to improving the security and especially the human rights of North Koreans.

Humanitarian Aid

A very important factor that must come in conjuncture with policy is humanitarian aid. North Korea has very little, if any, social welfare programs set up for its people (Kang & Watts, 2012). What aid the country does provide is almost always for the benefit of the military. With that said, most all aid given to the North Korean people is now coming from outside sources (Smith, 1999). Although North Korea is commonly referred to as the “hermit kingdom” (Strand, 2004, p.20) and has a wide reputation of not letting anyone from the outside in, this is not entirely true. There have been many government and non-government organizations (NGOs) that have worked in North

Korea, especially during the famine of the 1990s (Liem, 1999). Sadly though, many of these programs have been ineffective.

This section will highlight the characteristics of successful humanitarian organizations working in North Korea. These characteristics are based on what research has proven to be effective practice. In addition, qualitative research is provided by Dr.

Toshima, Intercultural Studies professor and founder of his own organization working in

North Korea. These stories and insight paint a great picture of what a NGO is truly able to accomplish in this nation while following these best practices. The characteristics humanitarian aid organizations should seek to exemplify are expounded upon below:

SOCIAL WORK WITH NORTH KOREAN 26

Successful humanitarian organizations stay far away from political agendas.

Although the policy and adjoining practices discussed in the section above could be critical in helping the nation of North Korea as a whole, policy and humanitarian aid must be practiced as two separate areas of social work. Throughout a wide body of research, the absolute biggest indicator for failed humanitarian work was mixing in political agenda (Lee, 2003). Because most government organizations, and even some

NGOs, came in with the intent to influence the country politically, not just provide for the peoples’ immediate needs, they were ultimately not trusted and unable to create programs with a lasting impact (Smrke, 2011). Once the North Korean officials realized the intent of said organizations, the projects never lasted, as the Korean officials perceived the organizations as a threat to their power and all helping efforts were quickly shut down

(Smrke, 2011).

Luckily, there have been a few organizations that have been able to move past political concerns in order to bring help to those who really needed it. Some of these organizations include the American Friends Service Committee, the Eugene Bell

Foundation, Christian Friends of Korea, and Global Resource Services (Snyder, 2007).

These organizations were characterized by putting the needs of the North Korean people above any political agenda (Snyder, 2007). In addition to these organizations, Dr.

Toshima’s organization (name omitted for confidentiality) has been successful largely because of the absence of political agenda in their work. The following quote is what Dr.

Toshima had to say on the topic:

I think one thing is, I’m apolitical. From the very beginning, even the people at

the UN, they know we have no concern about an agenda for America, or South SOCIAL WORK WITH NORTH KOREAN 27

Korea, or anything else. These are not our concerns. Our concern is to help

children in need, and they understood that we wanted to help them and the poor

people. Obviously they had their agenda of what they’re going to allow you to

do and all that, and I understood that, but we would not get involved in any

of that, because they tend to bait you to find out where you are politically. You

know, what do you think about this or that. And you just don’t bite on those

kinds of things. So I think if you just keep your heart pure and focus on

compassion and the needs of people, and know they’re not the evil people of the

world necessarily, which we kind of think. Pyongyang has some unbelievable

people (Toshima, personal communication, November 30, 2015).

Keeping a humanitarian aid organization void of political bias lies not only in its actions, but in its funding as well. In Snyder’s evaluation of NGOs in North Korea

(2007), he reports that receiving funds strictly from non-governmental sources is another characteristic of successful humanitarian work. Money most often comes with influence, and even if it doesn’t, it would be easy for North Korean officials to assume that whoever is backing any project financially is influencing that project.

This is another characteristic of Dr. Toshima’s organization that sets it apart. Dr.

Toshima reported that funds are all raised through compassionate donors, often churches.

Even when many of the projects had funds coming from South Korea, they were from one of the main churches in Seoul, not the government (Toshima, personal communication, November 30, 2015). Although it may be more difficult to raise money this way, it is what has helped Dr. Toshima’s organization, along with many others, continue to remain apolitical and active in helping North Korea. SOCIAL WORK WITH NORTH KOREAN 28

Successful humanitarian aid organizations are in it for the long haul.

According to research, a second large indicator of unsuccessful aid was short-term work (Snyder, 2007). Organizations that made entrance to North Korea and quickly exited rarely left anything sustainable in the country, as one might expect. Successful

NGOs were not only committed to North Korea for the long haul, but deepened that commitment by developing joint-programs with the North Korean government (Snyder,

2007). These joint programs were upheld with frequent visits and monitoring.

In the researcher’s interview with Dr. Toshima, he agreed with this quality of a successful organization immensely. Dr. Toshima has been to North Korea himself three times. Following is a summary of these trips, and the good his organization was able to do by committing to and working with the North Korean people.

I’ve been there three times, to North Korea. The first time was due to a real

drought, and there were just a lot of problems. Their crops were failing and all

this. They grow a lot of corn that they grind their noodles out of, which is a staple

for their diets… So I helped raise some money and we went in with twelve

thousand 100-pound bags of grain that we purchased in China and then brought

in by train, and they helped us do all this of course. So we bought it and then one

of the main keys was that we wouldn’t just give it to them because we were

concerned it would just go to the military. So they said ok, they would not let

me talk to the people through an interpreter, but they would let me go where they

unloaded the train in some of these devastating areas, and then they brought some

(grain) where they grind the grain into a meal so they can make the noodles. So SOCIAL WORK WITH NORTH KOREAN 29

that was kind of the deal (Toshima, personal communication, November 30,

2015).

Also, one other time I went in and they had a very serious problem with

not that much medication. I’ve visited several hospitals and it’s hard to imagine,

they had no pain relievers, not even Aspirin. So with the Korean’s help, them in

the states, especially New York, we took one hundred and seven boxes of

pharmaceuticals, high power medication, antibiotics. This was probably my

second trip. My second trip was when we visited several hospitals out in the

country. That’s when I saw several kids eating bark off trees ‘cause there was just

no food in the area. But still, they (the North Korean officials) don’t worry about

that. They’re only concerned about the people that live in Pyongyang, seemingly.

But the part that made me a little bit ‘twerked, we have to go through Beijing.

You have to fly through Koryo, that’s the North Korean airline that flies back and

forth from Beijing, that’s kind of the stopping place. They may have other flights

now, I don’t know. But, you know, just to tell you, you don’t have to put this in

your report but to me its interesting, but they were not going to let me bring these

medications in. As desperate as they are, they were holding them up in Beijing;

they were in a hold in Beijing airport. And so one of the North Korean guys that

lives in the (United States that knows them and works there, he said “Well, I think

if you go offer them one hundred dollars each to those three people behind the

counter, they’ll put them on the airplane.” So that’s exactly what I did, and they

let them all go on. And so, that’s a lot of mediations, one hundred and seven

boxes. But then when we got to Pyongyang, I went to go and get the medication SOCIAL WORK WITH NORTH KOREAN 30

and take it, because it was going to different hospitals, children’s hospitals, and I

think they had taken like twenty of the boxes. And I was going to fight them for

them, and my North Korean friend came to me and said, “Let it go. They’re not

going to give them back.” They took some for their military, obviously. So

anyway, we distributed that medication around, but it’s so little compared to the

need, its just unreal (Toshima, personal communication, November 30, 2015).

But another trip I went with seventeen Koreans who were from the North

but live in the states, and that was very very interesting. We brought them back

with us and it’s interesting, Koreans will gather things for their friends, it seems to

be part of their culture. And one Korean, an elderly man, had stuff he gathered for

50 years for his family. You know little things for his sisters and brothers, and he

was a teenager when he left, but his family was still there. He ran because when

the communists came a lot of young boys knew they would be constricted, so he

went to the South. But they let us make contact with his family. His mom and dad

had died, but his four sisters and brother all met together after 50 years; it was a

very emotional time. I noticed one of the North Korean guys that was there

choked up emotionally, so they’re not all hearts of stone you know (laughter). So

they were also touched by this (Toshima, personal communication, November 30,

2015).

Also, the last trip I took in, they were kind enough and they said to me,

“Why don’t you bring your leader here?” So we brought him into North Korea,

and interestingly, they put us up in a government house, much better place than

before. They have one hotel where all the foreigners stay. But they put us up in a SOCIAL WORK WITH NORTH KOREAN 31

kind of chalet, for officers and things, and fed us very well, so they were

obviously trying to make an impression. And you know (Dr. Toshima’s leader)

was there, so in that way they were trying to let the world know somehow that

they have religious freedom or that they’re normal, which doesn’t play out well.

But still, they tried (Toshima, personal communication, November 30, 2015).

When analyzing qualitative research, researchers often look for themes in narratives. Such themes can be derived from the narratives supplied by Dr. Toshima.

Primarily, each of his trips to North Korea were motivated by the desire to help others.

Whether it was through grain, medication, or anything other gift, the purpose was always to meet the needs of those who needed help the most. Secondly, Dr. Toshima was committed to the country for the long haul. He traveled to North Korea multiple times over the years, and continued supplying aid through his organization even when he wasn’t there.

It is evident that this consistency earned the trust of the North Korean people, and even their officials. The fact that government officials asked Dr. Toshima to invite his own “leader” back to their nation, a truly uncommon gesture in a nation of such high security, is solid evidence to this.

Additional research has shown that this type of developed trust has not only worked for the benefit of specific individuals, like Dr. Toshima, but has developed an almost popular support for assistance to the poor and other humanitarian aid actions

(Lumsdaine & Schopf, 2007). This kind of trust and support is essential not only to maintain one organization, but a continued humanitarian presence for years to come.

SOCIAL WORK WITH NORTH KOREAN 32

Successful humanitarian aid organizations are often faith-based.

This is a very interesting aspect of many successful NGOs that is worth addressing. To any outsider, it seems very unlikely that faith-based organizations, specifically Christian organizations, would succeed in any work with North Koreans, let alone in the country itself. It is even hard for many to imagine Christian groups entering such a totalitarian and anti-religious nation. Nonetheless, faith-based NGOs continue to thrive in North Korea (Snyder, 2007).

Some have speculated that this success stemmed out of North Korea’s religious roots. Pyongyang was in fact once a hub for religious diversity (Watts & Kang, 2012).

Even now, although North Korea claims to be nonreligious, the Juche philosophy paired with the worship of the Kim dynasty has essentially built North Korea a religion of their own (Watts & Kang, 2012). Still, would this religious commonality be enough to bring success to Christian humanitarian aid organizations?

It seems that these Christian organizations may have in fact taken the advise of religious scholar Jooseop Keum, whether they meant to do so or not. In his article on

Christianity in North Korea, Keum advises individuals seeking to make an impact to pursue the state, the church, and the North Korean people as three separate entities

(Keum, 2002). In his experience, this model has proven the most successful, not only for organizations, Christian and non-religious alike, but for the North Korean people as well

(Keum, 2002).

Dr. Toshima and his organization are another example of a successful faith-based group working in North Korea. They have had success, not only in spite of their religious SOCIAL WORK WITH NORTH KOREAN 33 beliefs, but at times because of those beliefs. Dr. Toshima recounts some of his experiences concerning religion and aid in the following excerpt:

I was there once and they told me about how the South Koreans came in, they’re

in Pyongyang, and all of a sudden, in one of these holidays where they got all

these people around, and these guys rip open their shirts and they’ve got “Jesus

Saves” in Korean written on them (laughter). And that really doesn’t do much

good. They of course got kicked out and they’ll never go back but they don’t care

probably (Toshima, personal communication, November 30, 2015).

It is evident that these kinds of religious groups are not the ones making a lasting impact in North Korea. Luckily, Dr. Toshima took a different approach to applying his faith to his aid.

They’ve been kind to me; they’ve allowed me to preach twice. They have two

churches in Pyongyang and I preached at both of them. Now I realize everybody

that was there was forced to be there, its not like they wanted to come hear this A

merican guy talk about Christianity. But still, I had the chance to talk about the

grace of God and about Jesus, and that was interpreted by my friend, who left

when he was a boy (Toshima, personal communication, November 30, 2015).

In addition to speaking in formal churches, Dr. Toshima even received an opportunity to discuss his religious beliefs personally with high-ranking North Korean officials. He recounts the story below:

I don’t know if I told you, but I spent, it think it was the first or second trip in,

but I spent a few hours talking to their officials about their philosophy. And they

took me to where Kim Il Sung was supposed to have grown up, and they’re kind SOCIAL WORK WITH NORTH KOREAN 34

of like holy sites to the people, because they kind of worship him. I happened to

be there on May 10th when they have the big parade, thousands and thousands of

people in the square, it’s a sight to see, but it’s a very controlled environment,

that’s the best way I can explain it. But any case, talking to these officials, and

they had an interpreter, and I had a Korean medical doctor with me, she was a

doctor who worked for the state of New York, real sharp lady. We talked with

them for hours about Juche. They took us to the tower, and about all the

philosophy, which to me is not that Communistic, you know it’s not like

Leninism or Mao, they identify that, but it’s a self help religion is what it is; its

basically humanism. Anyways, we talked and I listened and then after about three

hours they said, “Well, we’ll stop.” And I said, “No we can’t stop!” They said,

“What do you mean?” and I said, “You haven’t given me a chance to talk.” They

said, “Oh you want to talk?” And I said, “Yea!” So I talked to them about the

kingdom of God for about an hour. And they think America, what we are is

Christian. They don’t understand that this is all a political system and Jesus and

his teachings and all this. So I talked to them for a long time about Jesus and his

Kingdom and what he comes to do, and that American is not the kingdom,

and that they can also participate in this; in what Jesus’ life meant. So after this

we were going to break and he says, “You know, you ought to work for the state

department. We understand you better than we understand the people from the

state department!” (Laughter) So anyway, it was a very interesting experience

(Toshima, personal communication, November 30, 2015). SOCIAL WORK WITH NORTH KOREAN 35

The two previous encounters are probably very rare in humanitarian interactions with North Koreans (Ryu, 2007). Nonetheless, it is advised that faith conversations, whatever the content, be directed with mutual respect, and have no strings attached to the aid already being provided.

Successful humanitarian aid organizations act honorably towards the nation of North

Korean, and are sensitive to their specific needs.

Snyder’s (2007) last suggestion for NGOs is to act honorably, sensitively, and act based on the practical needs of the North Korean people. In other words, humanitarian aid organizations should adopt an “it’s about them, not us” mentality.

It would be ignorant to suggest that helpers, especially American helpers, would be able to enter North Korea without previous biases. As was displayed in the previous section on policy, there are great disparities between American and North Korean values.

This could apply to how money is spent, how people are treated, what the government can and cannot control, and so much more. But this does not negate the fact that the

North Korean people, including the government officials, deserve to be treated with respect. Even if such respect was not deserved, organizations cannot last in the country without it (Bae, 2014) Dr. Toshima had some valuable insight into this subject as well:

So I think if you just keep your heart pure and focus on compassion and the

needs of people, and know they’re not the evil people of the world necessarily,

which we kind of think. Pyongyang has some unbelievable people… (Toshima,

personal communication, November 30, 2015).

Dr. Toshima went on to discuss the importance of not publishing negative information about North Korea, as they are aware and read what is published concerning SOCIAL WORK WITH NORTH KOREAN 36 them. As one can deduce from the previous excerpt, it was essential to Dr. Toshima that he not slander the North Korean people, no matter their differences in values. He talks more about how he fought to preserve his respectful relationship with North Korea below:

Now when I was, this is interesting, when I was going into North Korea one

time, there was a correspondent from one of the major APs, one of the major

agencies, that could not get in. And she wanted me to take her in as part of my

crew, which I wouldn’t do, because that’s a dead give away to me. They want to

take pictures. What they want to do is they want to go to some orphanage and take

pictures of these kids and say this is, you know… Well I’ve seen those pictures;

I’ve been to those places. But I’ve also been to others where the kids are well

taken care of, well fed. So those things really aren’t fair… You just have to be

really careful not to do anything that would hurt. But its very possible, I don’t

think its impossible to go as a humanitarian or compassion ministry and do these

kinds of things, but it takes money, you know, and a lot of grace, you know not to

say things when you want to say things (laughter) (Toshima, personal

communication, November 30, 2015).

As Dr. Toshima mentioned, giving grace is essential in working with North

Korea, especially when dealing with the government or officials. This last story perfectly exemplifies an attitude of grace and humility; an attitude that should be possessed by every social worker or practitioner working in North Korea:

One thing is, they have a hotel in the city that’s one hundred and three stories

high, but the building is not used because its slanted and the elevators can’t go up SOCIAL WORK WITH NORTH KOREAN 37

and down. It’s easy for you to depreciate that and think “Oh that’s stupid!” but

you just have to think, “Ah, anybody can make mistakes. They probably weren’t

ready for that kind of architecture.” I think that’s the main thing, to be kind and

not to belittle people and try to say that you’re better in any way, like the ugly

American would do (Toshima, personal communication, November 30, 2015).

It is evident that this mentality, this pushing away from the “ugly American” and drawing into an attitude of grace, is what keeps one sustained as a humanitarian organization working in North Korea.

SOCIAL WORK WITH NORTH KOREAN 38

Chapter Five: Conclusion

In the year 1953, the new country of North Korea was hardly anything but shambles left from a bitter civil war. Today, in the year 2016, although there are still significant strides to be made, the nation of North Korea is not where it once was. It is going to take the action of social workers and other helping professionals to usher North

Korea into its next great era of improvement. By addressing the needs of individual North

Korean refugees, including their mental health and reintegration needs, change will begin to occur. By addressing the needs of the nation of North Korea as a whole through enacting new international policies and humanitarian aid projects, change will begin to occur. It is this change, built on a foundation of best practices, that will help restore what once was, and bring about what can be in the nation of North Korea.

SOCIAL WORK WITH NORTH KOREAN 39

References

Aaltola, M. (1999). Emergency food aid as a means of political persuasion in the North

Korean famine. Third World Quarterly, 20(2), 371–386. doi:

10.1080/01436599913802

Bae, J. (2014). Dialogue with North Korea? Preconditions for talking human rights with a

hermit kingdom. Copenhagen Journal of Asian Studies, 32(1), 102–104.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&db=bth&AN=98908097&site=ehost-live&scope=site

Bidet, E. (2009). Social capital and work integration of migrants: The case of North

Korean defectors in South Korea. Asian Perspective, 33(2), 151–179.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&db=sih&AN=44904547&site=ehost-live&scope=site

Bogic, M., Njoku, A., & Priebe, S. (2015). Long-term mental health of war-refugees: A

systematic literature review. BMC International Health & Human Rights, 15, 1–

41. doi: 10.1186/s12914-015-0064-9

Bo-hyuk Suh. (2013). Beyond silence and blaming: Revisiting South Korea’s role in

North Korean human rights. Asian Perspective, 37(1), 77–97.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&db=sih&AN=85953643&site=ehost-live&scope=site

Byllesby, B. M., Durham, T. A., Forbes, D., Armour, C., & Elhai, J. D. (2016). An

investigation of PTSD’s core dimensions and relations with anxiety and

depression. Psychological Trauma: Theory, Research, Practice, and Policy, 8(2),

214–217. doi: 10.1037/tra0000081 SOCIAL WORK WITH NORTH KOREAN 40

Chang, P. (2016) In person interview. May 25, 2016.

China’s repatriation of North Korean refugees: Hearing before the Congressional-

Executive Commission on China, 112th Cong. 20 (March 5, 2012) (testimony of

T. Kumar).

Cho, D. and Kim, Y. (2011). A study on settlement service for North Korean defectors.

Journal of Korean Public Police and Security Studies, 8(2), 25-50.

Cho, Y.-A., Jeun, W.-T., Yu, J.-J., & Um, J.-S. (2005). Predictors of depression among

North Korean defectors: A 3-year follow-up study. Korean Journal of

Counseling and Psychotherapy, 17, 467–484.

Chung, E. (2013). Long-stalled six-party talks on North Korea’s nuclear program:

Positions of countries involved. Korean Journal of Defense Analysis, 25(1), 1–15.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=poh&AN=89362780&site=ehost-live&scope=site

Chung, S., & Seo, J.-Y. (2007). A study on Posttraumatic Stress Disorder among North

Korean defectors and their social adjustment in South Korea. Journal of Loss and

Trauma, 12(4), 365–382. doi: 10.1080/15325020701296836

Delury, J. (2012). Triple-pronged engagement: China’s approach to North Korea.

American Foreign Policy Interests, 34(2), 69–73.

doi:10.1080/10803920.2012.665293

Drožđek, B. (2015). Challenges in treatment of posttraumatic stress disorder in refugees:

Towards integration of evidence-based treatments with contextual and culture-

sensitive perspectives. European Journal of Psychotraumatology, 6, 1–8. doi:

10.3402/ejpt.v6.24750 SOCIAL WORK WITH NORTH KOREAN 41

Drožđek, B., Kamperman, A., Tol, W. A., Knipscheer, J. W., & Kleber, R. J. (2014).

Seven- year follow-up study of symptoms in asylum seekers and refugees with

PTSD treated with trauma-focused groups. Journal of Clinical Psychology,

70(4), 376-387. doi: 10.1002/jclp.22035.

Drummond, P. D., Lee, C. W., & McGuire, T. M. (2014). Potential of eye movement

desensitization and reprocessing therapy in the treatment of Post-Traumatic Stress

Disorder. Psychology Research & Behavior Management, 7, 273–283. doi:

10.2147/PRBM.S52268

Howe, B. (2012). Lessons learned for promoting human security in North Korea. Korean

Journal of Defense Analysis, 24(4), 481–487.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=

true&d b=poh&AN=102231993&site=ehost-live&scope=site

Hoge, J., Kim, B. Y., Lin, L., Ogawa, M., & Zhao, Y. (2009). Whose history? An

analysis of the Korean war in history textbooks from the United States, South

Korea, Japan, and China. Social Studies, 100(5), 222–232.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=a9h&AN=44732498&site=ehost-live&scope=site

Hwang, J. & Kim, J. (2006). Defining the limits of the North Korean Human Rights Act:

A security and legal perspective. East Asia: An International Quarterly, 23(4),

45–60.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=a9h&AN=25088135&site=ehost-live&scope=site SOCIAL WORK WITH NORTH KOREAN 42

Jin, K., & Yeol, Y. (2014). National identity as a mediator of the relationship between

perceived discrimination and social adaptation among North Korean refugees.

Korean Journal of Defense Analysis, 26(4), 447–469.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=poh&AN=100164188&site=ehost-live&scope=site

Jin Yong, J., Yu-Jin G., L., So-Hee Lee, So Young, Y., Jungeun Song, & Seog Ju, K.

(2015). Association between defense mechanisms and psychiatric symptoms in

North Korean refugees. Comprehensive Psychiatry, 56, 179–187.

http://doi.org/10.1016/j.comppsych.2014.10.001

Kang, S.-Y., & Watts, T. D. (2012). Social welfare in North Korea: Ethical and

ideological conflicts and dilemmas. Journal of Comparative Social Welfare,

28(1), 17–22. doi: 10.1080/17486831.2011.595079

Keum, J. (2002). Church, minjung, and state: The revival of protestant christianity in

North Korea. Studies in World Christianity, 8(2), 264–284.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=a9h&AN=12567860&site=ehost-live&scope=site

Kim, H. S., Kim, G. K.-H., & Torrey, B. (2008). Reflections on North Korea: The

psychological foundation of the North Korean regime and its governing

philosophy. International Bulletin of Missionary Research, 32(1), 22–26.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=rfh&AN=ATLA0001630228&site=ehost-live&scope=site SOCIAL WORK WITH NORTH KOREAN 43

Kim, S.-H., Kim, H. K., & Lee, N. (2013). Psychological features of North Korean

female refugees on the MMPI-2: Latent profile analysis. Psychological

Assessment, 25(4), 1091–1102. doi: 10.1037/a0033097

Kim, T. (2012). Strategizing aid: US–China food aid relations to North Korea in the

1990s. International Relations of the Asia-Pacific, 12(1), 41–70.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=poh&AN=70005469&site=ehost-live&scope=site

Lee, M., (2012). A step as normative power: The EU’s human rights policy towards

North Korea. Asia Europe Journal, 10(1), 41–56. doi: 10.1007/s10308-012-

0318-2

Lee, N. & Sohn, A. (2012). A study on the attitude of South Koreans towards North

Korean defectors: Focusing on national identity and multi-cultural acceptability.

Journal of Asia Pacific Studies, 19(3), 5-32.

Lee, S. (2003). International engagement in North Korea’s humanitarian crisis: The role

of state and non-state actors. East Asia: An International Quarterly, 20(2), 74–93.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=a9h&AN=12618354&site=ehost-live&scope=site

Liem, R. (1999). Silent famine in North Korea. Peace Review, 11(2), 325-331.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=poh&AN=2074039&site=ehost-live&scope=site

SOCIAL WORK WITH NORTH KOREAN 44

Lough, B. J. (2014). Social work perspectives on international volunteer service. British

Journal of Social Work, 44(5), 1340–1355.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=sih&AN=97238366&site=ehost-live&scope=site

Lumsdaine, D., & Schopf, J. C. (2007). Changing values and the recent rise in Korean

development assistance. Pacific Review, 20(2), 221–255. doi:

10.1080/09512740701306881

Maass, M. (2014). Towards gendering northeast Asian traditional security: The cases of

the USS pueblo and juche policy. Korean Journal of Defense Analysis, 26(2),

243–262.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=poh&AN=96715186&site=ehost-live&scope=site

Mosley, J. (2013) Recognizing new opportunities: Reconceptualizing policy advocacy in

everyday organizational practice. Social Work, 58(3), 231–239.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=rzh&AN=107968783&site=ehost-live&scope=site

Myers, B. (2008). Ideology as smokescreen: North Korea’s juche thought. Acta

Koreana, 11(3), 161–182.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=sih&AN=36048813&site=ehost-live&scope=site

SOCIAL WORK WITH NORTH KOREAN 45

Myong-Hyun, G. (2014). Resettling in South Korea: Challenges for young North Korean

refugees. The Asian Institute for Policy Studies, 24. Retrieved from

http://en.asaninst.org/contents/resettling-in-south-korea-challenges-for-young-

north-korean-refugees/

Jeon, W.T., Eom, J. S., & Min, S. K. (2013). A 7-year follow-up study on the mental

health of North Korean defectors in South Korea. Journal of Traumatic Stress,

26(1), 158–164. doi: 10.1002/jts.21783

Jeon, W. T., Hong, C. H., Lee, C. H., Kim, D. K., Han, M. Y., & Min, S. K. (2005).

Correlation between traumatic events and posttraumatic stress disorder among

North Korean defectors in South Korea. Journal of Traumatic Stress, 18, 147–

154. doi:10.1002/jts.20017

Jeon, W. T., Min, S. K., Lee, M. H., & Lee, E. S. (1997). A study on adaptation of North

Koreans in South Korea. Journal of Korean Neuropsychiatric Association, 36,

145–161.

Pak, S. (2010). The growth status of North Korean refugee children and adolescents from

6 to 19 years of age. Economics and Human Biology, 8, 385-395.

Ryu, D. Y. (2007). Religion, politics, and church construction in North Korea.

Theology Today, 63(4)

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=rfh&AN=ATLA0001553923&site=ehost-live&scope=site, 493–499.

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Shulong, C. & Xinzhu, L. (2008). The six party talks: A Chinese perspective. Asian

Perspective, 32(4), 29–43.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=sih&AN=36494717&site=ehost-live&scope=site

Smith, H. (1999). “Opening up” be default: North Korea, the humanitarian community

and the crisis. Pacific Review, 12(3), 453.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=a9h&AN=6690953&site=ehost-live&scope=site

Smrke, B. M. (2011). North Korea hunger, politicized: Examining the influence of

international and North Korean political Considerations on the efficacy of NGO

famine relief efforts from 1995 to the present. Undercurrent, 8(1), 76–89.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=a9h&AN=67211117&site=ehost-live&scope=site

Snyder, S. (2007). American religious NGOs in North Korea: A paradoxical relationship.

Ethics & International Affairs (Wiley-Blackwell), 21(4), 423–430. doi:

10.1111/j.1747-7093.2007.00116.x

Song, J. (2013). “Smuggled refugees”: The social construction of North Korean

migration. International Migration, 51(4), 158–173. doi: 10.1111/imig.12033

Strand, W. (2004). Opening the Hermit Kingdom. History Today, 54(1), 20–26.

https://seu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=t

rue&d b=hft&AN=503907712&site=ehost-live&scope=site

Toshima, B. (2016). In person interview. November 30, 2015. SOCIAL WORK WITH NORTH KOREAN 47

Watts, B. V., Zayed, M. H., Llewellyn-Thomas, H., & Schnurr, P. P. (2016).

Understanding and meeting information needs for patients with posttraumatic

stress disorder. BMC Psychiatry, 16, 1–7. doi: 10.1186/s12888-016-0724-x

Watts, T. D. & Kang, S.-Y. (2012). Religious liberty in North Korea: Past and present.

Social Development Issues, 34(2), 28–36.

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Appendix A

Notes from Interview with Dr. Chang – May 25, 2015

A Chinese Perspective on North Korea

 The relationship between China and North Korea isn’t good – China sees North Korea as misbehaving child; are embarrassed by them.  North Korea is a bigger problem for China than for the US, they’re much closer  North Korea fears that China will take over  1st Kim (Kim Il Sung) had a better relationship with China because they fought together during World War II and the Korean War. He spoke and wrote Chinese.  After World War II, North Korea’s relationship with China deteriorated, while their relationship with Russia strengthened. Russia put a lot of money into North Korea.  During the Cultural Revolution, the red guard (young people) criticized a lot of Chinese leaders, along with Kim Il Sung.  After the Cultural Revolution, relations between China and North Korea improved. This was largely do to the support of communism.  Dung Shao Ping began a more direct approach with North Korea. - He visited North Korea, wasn’t happy with using China’s money to support “cult of leader.” - China opened up to outside world, including South Korea, and made North Korea upset. - North Korea felt betrayed, but China was insistent.  Kim Il Sung and Kin Jong Il were both very upset with China.  North Korea invited Jimmy Carter to their country to get back at China; wanted unilateral relationship with US, aka they wanted to bypass China.  Kim Il Sung dies of a heart attack.  Under Kim Jong Il, China continued to support North Korea because they didn’t want to be friends with the US. SOCIAL WORK WITH NORTH KOREAN 49

- North Korea played China and US against each other, had the power to make China lose face. - North Korea Continued to play China, US and Russia because North Korea was desperate for support.  China grows weary of North Korea causing problems for them.  Chines policy – no nuclear weapons in North Korea. - North Korea choses not to follow this policy. - These weapons weren’t being used to defend the Korean people; they were being used to defend the Kim family.  Chinese leader now – believes China shouldn’t allow North Korea to lead China.  Six Party Talks (China wants to have in Beijing). - US and China don’t want North Korea with nuclear weapons.  China and US pay North Korea to not do things, that’s how the government is sustaining.  Kim Jong Un has not yet come to China, although he secretly studied in England.  China wants good relations with North Korea; they know North Korea won’t survive without their help; they want North Korea to behave better.  China may keep supporting NK because they don’t want South Korea as a neighbor?  China might just want peace?  Nuclear weapons issue absolutely outweighs human rights issue.  **China may be afraid that other countries will use the same human rights arguments against them that are being used against North Korea.  It is easy for China to visit North Korea  Chinese money goes to food and gas for the North Korean military.  “When people don’t believe in God, it’s easy to elevate men to the place of God.”

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Appendix B

Interview with Dr. Toshima – November 30, 2015

Interviewer: …Tell me about your organization.

Dr. Toshima: Right now my organization is (name removed for confidentiality). What we’re doing at this present time is putting equipment into a hospital in Pyongyang. There are many parts of it. One of them is one of the main churches in South Korea is coming up with a lot of the funds. They’re doing this because they want to help North Koreas; it’s out of compassion obviously. They’re helping to build a hospital there, in Pyongyang, and we’re supplying equipment there, in this hospital. We have a doctor, who is a thoracic surgeon, and he goes to North Korea often, in fact he just came back. He will go and operate on any of the officials if they need help, and the key thing is if Kim Jong Un needs help they will call him. He’s South Korean but he’s American so he speaks Korean well and he’s a very sharp thoracic surgeon, so he’s built up that kind of report with them. So in a way, for a compassion ministry, we’re not helping maybe the poor people, which we would love to do, but still it gives us an entrance into the country, and we can help certain people.

I’ve been there three times, to North Korea. The first time was due to a real drought, and there were just a lot of problems. Their crops were failing and all this. They grow a lot of corn that they grind their noodles out of, which is a staple for their diets. I have a Korean friend who is a pastor in New York City and of course the UN is there.

And while there’s not a North Korean office in the UN, they do have a desk there. A guy SOCIAL WORK WITH NORTH KOREAN 51 name Lee (name changed for confidentiality) is the one that kept on asking him and me to come. My friend was originally from North Korea, but as a child they ran to the South when the communists came. There’s a half a million Korean in NYC and half the older ones came to the South when the communists came. So I helped raise some money and we went in with twelve thousand, one hundred pound bags of grain that we purchased in

China and then brought in by train, and they helped us do all this of course. So we bought it and then one of the main keys was that we wouldn’t just give it to them because we were concerned it would just go to the military. So they said ok, they would not let me talk to the people through an interpreter, but they would let me go where they unloaded the train in some of these devastating areas, and then they brought some (grain) where they grind the grain into a meal so they can make the noodles. So that was kind of the deal.

But another trip I went with seventeen Korean who were from the North but live in the states, and that was very very interesting. We brought them back with us and it’s interesting, Koreans will gather things for their friends, it seems to be part of their culture. And one Korean, an elderly man, had stuff he gathered for 50 years for his family. You know little things for his sisters and brothers, and he was a teenager when he left, but his family was still there. He ran because when the communists came a lot of young boys knew they would be constricted, so he went to the South. But they let us make contact with his family. His mom and dad had died, but his four sisters and brother all met together after 50 years, it was a very emotional time. I noticed one of the North

Korean guys that was there choked up emotionally, so they’re not all hearts of stone you know (laughter), so they were also touched by this. There were other families, but I SOCIAL WORK WITH NORTH KOREAN 52 remember this one especially. So that was one of the things they allowed, you know for the family to meet together, and they even allowed us to be with the family alone. We talked to them about the Lord, so you just hope that the truth came into their hearts.

They’ve been kind to me; they’ve allowed me to preach twice. They have two churches in Pyongyang and I preached at both of them. Now I realize everybody that was there was forced to be there, its not like they wanted to come hear this American guy talk about Christianity. But still, I had the chance to talk about the grace of God and about

Jesus, and that was interpreted by my friend, who left when he was a boy.

Also, one other time I went in and they had a very serious problem with not that much medication. I’ve visited several hospitals and it’s hard to imagine, they had no pain relievers, not even Aspirin. So with the Korean’s help, them in the states, especially New

York, we took one hundred and seven boxes of pharmaceuticals, high power medication, antibiotics. This was probably my second trip. My second trip was when we visited several hospitals out in the country. That’s when I saw several kids eating bark off trees

‘cause there was just no food in the area. But still, they don’t worry about that. They’re only concerned about the people that live in Pyongyang, seemingly. But anyway we took in all these medications, and you know it’s expensive. But the part that made me a little bit ‘twerked, we have to go through Beijing. You have to fly through Koryo, that’s the

North Korean airline that flies back and forth from Beijing, that’s kind of the stopping place. They may have other flights now, I don’t know. But, you know, just to tell you, you don’t have to put this in your report but to me its interesting, but they were not going to let me bring these medications in. As desperate as they are, they were holding them up in Beijing; they were in a hold in Beijing airport. And so one of the North Korean guys SOCIAL WORK WITH NORTH KOREAN 53 that lives in the states that knows them and works there, he said “Well, I think if you go offer them one hundred dollars each to those three people behind the counter, they’ll put them on the airplane.” So that’s exactly what I did, and they let them all go on. And so, that’s a lot of mediations, one hundred and seven boxes. But then when we got to

Pyongyang, I went to go and get the medication and take it, because it was going to different hospitals, children’s hospitals, and I think they had taken like twenty of the boxes. And I was going to fight them for them, and my North Korean friend came to me and said “Let it go. They’re not going to give them back.” They took some for their military, obviously. So anyway, we distributed that medication around, but it’s so little compared to the need, its just unreal.

Also, the last trip I took in, they were kind enough and they said to me, “Why don’t you bring your leader here?” So we brought him (Dr. Toshima’s boss) into North

Korea, and interestingly, they put us up in a government house, much better place than before. They have one hotel where all the foreigners stay. But they put us up in a kind of chalet, for officers and things, and fed us very well, so they were obviously trying to make an impression. And you know (Dr. Toshima’s boss) was there, so in that way they were trying to let the world know somehow that they have religious freedom or that they’re normal, which doesn’t play out well, but still they tried.

So he went on home and from there I went to Manchuria of China, on the North side of the river Yanji and all that. Me and my friend went across, there’s a bridge there between China and North Korea, there’s a river, and we went across that in a ambulance.

And they processed us through, because there’s an economic zone that we wanted to visit, which I didn’t know about, but it’s in the North and they’ll bring in ships that can SOCIAL WORK WITH NORTH KOREAN 54 take containers and things. So in this economic zone, I remember they were just looking at the possibility, they thought we could do more there. And I began to cook little cookies and stuff like that, in China and send them to the children and stuff like that. So they let us. We hired bakeries at night that were not cooking their regular stuff, and they would cook cookies for us. I don’t know how many times we did that, and somehow they let us do that, we really don’t know how they distributed them, we had to trust them to distribute them. But they were for the kids; we wanted them to go to schools. But anyway while we were there, there was a man, a Chinese fella, who has a university of about five thousand students, a technical university. So we invited him over, and he was building an orphanage that would house about six hundred kids in North Korea, in this economic zone. And interestingly we met him there so we talked with him and he said, “Can you supply food?” And we said, “Yea, we can supply the food. If you can get it in, we’ll get the food to feed these kids.” Well when we left, they put him under house arrest for six months. They actually took the buildings away from him. So it was kind of a difficult experience, so we were never able to do that.

So I have not been back to North Korea since that time. We were asked to ship in a printing press. I don’t know if I told you, but I spent, it think it was the first or second trip in, but I spent a few hours talking to their officials about their philosophy. And they took me to where Kim Il Sung was supposed to have grown up, and they’re kind of like holy sites to the people, because they kind of worship him. I happened to be there on May

10th when they have the big parade, thousands and thousands of people in the square, it’s a sight to see, but it’s a very controlled environment, that’s the best way I can explain it.

But any case, talking to these officials, and they had an interpreter, and I had a Korean SOCIAL WORK WITH NORTH KOREAN 55 medical doctor with me, she was a doctor who worked for the state of New York, real sharp lady. We talked with them for hours about Juche, they took us to the tower, and about all the philosophy, which to me is not that Communistic, you know its not like

Leninism or Mao, they identify that, but it’s a self help religion is what it is; its basically humanism. Anyways, we talked and I listened and then after about three hours they said,

“Well, we’ll stop.” And I said, “No we can’t stop.” They said, “What do you mean?” and

I said, “You haven’t given me a chance to talk.” They said, “Oh you want to talk?” And I said, “Yea!” So I talked to them about the kingdom of God for about an hour. And they think America, what we are is Christian, they don’t understand that this is all a political system and Jesus and his teachings and all this, so I talked to them for a long time about

Jesus and his Kingdom and what he comes to do, and that American is not the kingdom, and that they can also participate in this; in what Jesus’ life meant. So after this we were going to break and he says “You know, you aught to work for the state department. We understand you better than we understand the people from the state department.”

(Laughter) So anyway, it was a very interesting experience. I tried to keep contact with one of the young interpreters, sharp young guy, but they wouldn’t let me fax or email, they don’t allow any of that. So, and they’ve invited us to go back again, but I don’t know, I don’t think we can do much without some money, and I don’t have the funds to meet another humanitarian need. But you know, it’s not impossible. It can be done, and they do allow some Americans to come in, to teach English. I don’t know if they would allow someone to advise them, in the things your thinking, but with the right context, it’s probably possible.

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Interviewer: What do you think – a lot of my research has been looking at – there are a lot of organizations trying to help, but many are unsuccessful. What do you think has given you the upper hand, because the fact that you’ve been there three times, and they invited you, treated you well, listened to you, that’s really remarkable. What do you think has allowed that to happen?

Dr. Toshima: I think one this is, I’m apolitical. From the very beginning, even the people at the UN, they know we have no concern about an agenda for America, or South Korea, or anything else. These are not our concerns. Our concern is to help children in need, and they understood that we wanted to help them and the poor people. Obviously they had their agenda of what they’re going to allow you to do and all that, and I understood that, but we would not get involved in any of that, because they tend to bait you to find out where you are politically. You know, what do you think about this or that. And you just don’t bite on those kinds of things. So I think if you just keep your heart pure and focus on compassion and the needs of people, and know they’re not the evil people of the world necessarily, which we kind of think. Pyongyang has some unbelievable people. I’ve been to Kim Il Sung’s tomb, and it is, its like going to Linin’s tomb in Russia. I’ve never been there but I’ve been to Ho Chi Minh’s tomb in Hanoi and its very similar, and its almost like a sacred sight for them. You have to respect that, and I think we walked up almost six hundred steps to get to this place. We rode a special train going up obviously because its like a sacred mountain. But if you show respect and when you come home not publish, because you know they read things, not publishing things that are negative and all this. SOCIAL WORK WITH NORTH KOREAN 57

They took me, maybe it was the last trip or the next to last trip, when I landed at the airport the same guy took me out to where they have this statue of Kim Il Sung, its seventy feet high; it’s huge. And they had a TV camera there, and they’re asking me to go and bow before this, and I just said, “I can’t do that. I’m going to respect your leader, that’s no problem, but I don’t want them to put me on the TV program saying Americans have come to do this.” And they understood that, they didn’t get upset. I just think if I would have done that they would have thought there was something wrong with this guy, they know I couldn’t do that. In their hearts, they knew he’s probably not going to bow before, but if he does that means he probably wants something. But I think if you’re just honest, keep your Christian principles and treat them with respect it’s amazing.

One thing is, they have a hotel in town in the city that’s one hundred and three stories high, but the building not used because its slanted and the elevators cant go up and down. Its easy for you to depreciate that and think “oh that’s stupid,” but you just have to think, “ah, anybody can make mistakes and they probably weren’t ready for that kind of architecture.” But I think that’s the main thing, to be kind and not to belittle people and try to say that you’re better in any way, like the ugly American would do.

Interviewer: I know it may be hard to think because there are so many needs that they still have, but what do you see as, maybe your organization or others, what do you see as being the next step or the next thing if someone is wanting to help, where’s the place to start?

SOCIAL WORK WITH NORTH KOREAN 58

Dr. Toshima: Well I think one thing is getting real information which is difficult; true information. Its so closed there’s not much way you can find out. So I think you would have to build some relationship with some people like at the UN or someone to find out, and they know what the real needs are. And so we talked with them, and like I said, there was a flood one time that hit part of the coast, so we brought in a bunch of food so we could respond to a real need, we felt. So that’s the key, but there are certain people who can help you do this. It may be good if you can have some people on the inside, which is not easy, but inside the country, and just kind of assess, like some English teachers, and generally they’re going to be in Pyongyang, but if they could get outside, that would really help to really know what the situation is. But I think if you had an organization or if I said we wanted to do something there, I would go to New York and meet with the people and just say, “We want to help, what can we do, what would you allow us to do?”

And they probably would, to begin the work it takes a lot of red tape, it takes some time, but generally they would probably come up with two or three things like they did with us and the medicine. We knew there was a need for medicine, they didn’t have any in some of the hospitals, and so that was a need we were able to fulfill. And pharmaceuticals in

America are really good, like our little mission in the last years put in forty four million dollars of medication into Honduras, these high-powered antibiotics. And they gave all this, the pharmaceuticals, gave all that as long as we would distribute it overseas, you cant do that in the states. So I mean its possible to do that kind of thing. So I would say especially if you’re going to work in hospitals, if you’re going to work as part of their sociological or psychological needs, I would go at it from the hospital stand point. I met SOCIAL WORK WITH NORTH KOREAN 59 with many hospital officials, and obviously they’re going to be careful, they want to live, but they would probably tell you what you can do or what there needs are.

I don’t know exactly but I sometimes, like physical therapists, I’ve taken a physical therapist when Cambodia was communist, they had no idea. I took in a physical therapist, she was about your age, and this gal I mean, they had people who were told they would never walk, this gal had them walking in a day. She knew how to manipulate the muscles and things, and they had no concept of that. They just thought they were going to be bed ridden for the rest of their lives. But she had a certain gift, obviously she was good, and certain knowledge, she had studied, so there may be things like that because they’re so closed off from the world, that maybe some things in that area, you know maybe medications that they need or you know having trauma, whatever. That’s what I would do, and I think it could work. They would probably say ok, and it would take a year probably to work out all the details.

Recently they’ve invited us back, my friend, and you know, every time we’ve gone in we’ve taken in a lot of gifts. So its not because I’m me you know, its because of the gift you bring. Twelve thousand one hundred pound bags of grain was close to two hundred thousand dollars, plus about one hundred and seven thousand dollars that we raised, so of course they let us come.

So, now there’s this guys who’s a basketball player who’s coo-coo. And they love basketball, so he’s been able to go in. So maybe sports. Now one of your friends did this,

I was the supervisor for her paper, and I think you know there is something to that, but I think humanitarian is a much bigger door to go through. Its just the needs, you know, if you could focus, I would focus on children, and some of the trauma that they are facing. SOCIAL WORK WITH NORTH KOREAN 60

I’m sure they have Autistic kids, and they probably don’t know that much about dealing with Autism, you know that kind of thing. I think you know you could build a friendship and probably have access.

Now when I was, this is interesting, when I was going into North Korea one time, there was a correspondent from one of the major APs, one of the major agencies, that could not get in. And she wanted me to take her in as part of my crew, which I wouldn’t do. Because that’s a dead give away to me. They want to take pictures. What they want to do is they want to go to some orphanage and take pictures of these kids and say this is, you know… Well I’ve seen those pictures; I’ve been to those places. But I’ve also been to others where the kids are well taken care of, well fed. So those things really aren’t fair.

Interviewer: Yea, and it seems like it would really close the door for future work.

Dr. Toshima: Exactly. Yea no, I just, you just have to be really careful not to do anything that would hurt. But its very possible, I don’t think its impossible to go as a humanitarian or compassion ministry and do these kinds of things, but it takes money, you know, and a lot of grace, you know not to say things when you want to say things (laughter).

Interviwer: Yea, well that sounds like great advise. I think that’s definitely useful for people to know. In research that’s one of the biggest things I found. Not being political, because I think most of them that were unsuccessful were coming from South Korea or other neighboring countries trying to get a little edge to influence the government or whatever, and those just didn’t last.